Systems, devices, and associated methods for neuromodulation with enhanced nerve targeting

A system, comprising:

• a neuromodulation catheter including:
• an elongated shaft having a distal portion configured to be intravascularly positioned at a target site within a blood vessel of a human patient, and
• a plurality of ablation electrodes spaced apart along the distal portion of the shaft, the plurality of ablation electrodes including a first ablation electrode and a second ablation electrode, wherein the ablation electrodes are configured to deliver neuromodulation energy to target nerves at or adjacent the target site;
• a plurality of reference electrodes configured to be positioned at the patient's skin, the reference electrodes including a first reference electrode and a second reference electrode;
• a controller configured to be communicatively coupled to the ablation electrodes and the references electrodes, wherein the controller is further configured to:
• obtain a first impedance measurement between the first ablation electrode and the first reference electrode,
• obtain a second impedance measurement between the first ablation electrode and the second reference electrode,
• obtain a third impedance measurement between the second ablation electrode and the first reference electrode,
• obtain a fourth impedance measurement between the second ablation electrode and the second reference electrode,
• compare the first impedance measurement, the second impedance measurement, the third impedance measurement, and the fourth impedance measurement to at least one reference impedance value, and
• based on comparison of the first impedance measurement, the second impedance measurement, the third impedance measurement, and the fourth impedance measurement to the at least one reference impedance value:
• (a) identify a first electrode group consisting of the first ablation electrode and one of the first reference electrode or the second reference electrode, and (b) identify a second electrode group consisting of the second ablation electrode and the other of the first reference electrode or the second reference electrode, wherein the first electrode group and the second electrode group are selected to achieve at least one of a desired direction or a desired three-dimensional shape of an electric field during subsequent energy delivery through at least one of the first electrode group or the second electrode group.